Healthcare Provider Details

I. General information

NPI: 1912204280
Provider Name (Legal Business Name): SPORTS INJURY DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N BRAND BLVD SUITE B
GLENDALE CA
91202-3070
US

IV. Provider business mailing address

1111 N BRAND BLVD SUITE B
GLENDALE CA
91202-3070
US

V. Phone/Fax

Practice location:
  • Phone: 818-319-7249
  • Fax:
Mailing address:
  • Phone: 818-319-7249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. JANINE MOROVATI
Title or Position: PRESIDENT
Credential: DC
Phone: 818-319-7249